Nurse Preceptors\u27 Perceptions of Non-Traditional Education

Background: A preceptor is an experienced nurse who teaches and provides feedback to a new orientee on their professional practice for a designated time. The preceptor is the key educator for new nurses in their learning process. Continuing education for the nurse preceptor is necessary to foster the professional development of this complex role. Aims: The purpose of this study is to determine if nurse preceptors perceive non traditional education as effective as in person instruction for preceptor professional development. Methods: This descriptive study used a convenient sample. An educational journal was created covering a variety of topics that aide in the growth and development of the nurse preceptor. The education was sent electronically to nurse preceptors in a critical care setting. Preceptors were required to read the journal and complete a post test. Once completed, nurse preceptors were invited to participate in the study. A 25 item questionnaire, using a 5 point Likert scale, was sent via email. Nurse preceptors were given one month to voluntarily participate in the study. Responses to the survey were scored and averaged. Findings: There were a total of 14 participants. Not all items were answered by each participant. Eighty six percent were BSN prepared, 14% were MSN prepared. The majority of participants (71%, n= 10) have been preceptors for 2 or more years in their current practice setting. Some participants did not attend the previous in person preceptor education (4 out of 14). All participants completed the non traditional (journal) education. Nearly all participants (92%, n=12 out of 13) believed that the non traditional educational journal had high impact. When responding to educational preferences, 61.5% preferred to receive preceptor education in a non traditional format while 38% preferred to receive education in both non traditional and traditional formats. The study results provide a better understating of the educational preferences of the nurse preceptor. This information is vital for the development for future preceptor education programs. Tailoring education to the learners preferred methods can make education more impactful. Providing meaningful education to preceptors will improve their practice, further benefiting the experience of the newly hired/transferred nurses. The study may be applicable to other practice areas and/or organizations.https://scholarlycommons.henryford.com/nursresconf2021/1010/thumbnail.jp

Improving Early Detection of C. difficile Infections

Background: Patients with C. difficile will have liquid, loose, mucous like, or non formed stools. These infections can occur in both the inpatient and community settings and can range from diarrhea to life threatening illness. C. difficile positive stool samples collected within the first three calendar days of hospital admission is considered community acquired. Positive stool samples for C. difficile calendar day 4 or greater are considered hospital acquired. In 2019 and 2020, the P4 surgical intensive care unit (SICU) at Henry Ford Hospital (HFH) experienced high rates of hospital acquired C. difficile infections (CDI). Aim: The purpose of this project was to utilize an electronic health record (EHR) report to conduct early screening for patients to capture CDI during the community acquired timeframe rather than during the hospital acquired timeframe. Methods: Pre-post quasi-experimental retrospective study. Institutional Review Board approval was obtained. Incidence and rate of hospital acquired CDI were tracked from 2019-2022. All community-acquired CDI identified using the stool report were tracked from 2021-2022. Findings: Significant reductions occurred in unit incidence and rates of hospital acquired CDI (Table 2). During the study timeframe, 15 community acquired CDIs were successfully detected within the first 3 calendar days of hospital admission (7 in 2021, 8 in 2022). These infections were detected with the use of the stool report tool and CNS and/or IPC follow up. Without this tool, these CDIs may not have been identified during the community acquired infection timeline. Discussion: October 2021: A Loose Stool Best Practice Alert (BPA) was implemented. This electronic health record BPA alerts nursing staff of potential CDI during the community acquired window. The stool report remains a useful monitoring tool in the event that the Loose Stool BPA is bypassed. The CNS and IPC continue with daily screening of the stool report and follow up with nursing for all potential CDI patients. This quality improvement project is in the process of being expanded to additional units at the hospital. Implications: Delay in CDI detection can cause negative outcomes for patients and can result in inflated hospital acquired rates. Utilizing an electronic report in conjunction with clinical nurse specialist follow up, is an effective method for early screening for C. difficile.https://scholarlycommons.henryford.com/nursresconf2023/1000/thumbnail.jp

Using Interprofessional Collaboration to Reduce CLABSI Rates in an Intensive Care Setting

Background: Central line associated bloodstream infections (CLABSI) are preventable hospital-acquired infections associated with increased morbidity and mortality, and cost. CLABSIs are the most expensive healthcare associated infection (HAI) with a cost upwards of $90,000 per infection. This cost does not account for increased length of stay or future readmissions. The criteria used to define CLABSIs in an acute care setting is based on the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) definitions. An infection window period (IWP) is used to review infection criteria to meet the surveillance definition. This is defined as a 7 day period, which includes the 3 calendar days before and after the first positive diagnostic test (Table 1). If no secondary sources are identifiable as a cause of the bloodstream infection (BSI) within the IWP, it will qualify as a CLABSI based on the NHSN definition. Healthcare organizations are encouraged to adhere to evidence based central line (CL) insertion and maintenance practices to reduce infection, which include: Adherence to hand hygiene practices Insertion bundles Maintenance bundles Removal of CL when they are no longer indicated Despite improved compliance with these infection prevention interventions, the surgical intensive care unit (SICU) at Henry Ford Hospital (HFH) continued to experience high CLABSI rates in 2019 and 2020. Aims: Using an interprofessional proactive approach, this project\u27s goal was to reduce the number of NHSN reportable CLABSIs by identifying at risk patients and clinically assessing for alternative infection sources. Methods: An interprofessional team formed to better understand the occurrence of CLABSI on the surgical intensive care unit (SICU). The team included: Unit Medical Director Infection Prevention Specialist Clinical Nurse Specialist Multiple opportunities were identified when reviewing root cause analysis data: Care team documentation Assessments for alternative infection. Verification of blood culture indication following HFH Blood Culture Stewardship Guidelines IRB approval and a waiver of informed consent were obtained. The interprofessional team (Figure 1): Completed daily chart audits on patients with central access Screened patients for blood culture collection and result status Verified blood culture indication using the HFH Blood Culture Stewardship Guidelines Established an IWP and reviewed medical record for infection source once blood cultures were collected Shared findings with interprofessional team via secure messaging Communicated potential gaps with the patient care teams, which included collaborative efforts regarding the treatment plan and proper documentation of clinical findings This proactive approach ensured supporting evidence was present to meet NHSN definitions for secondary BSI to avoid CLABSIs This quasi experimental retrospective study compared data from the pre intervention period (January 2019 to January 2021) to the intervention period (March 2021 to December 2022): CLABSI rate per 1,000 CL days Blood culture order rate per 1,000 CL days CL utilization ratio per 1,000 patient days Standardized infection ratio The t test was used to compare the continuous variables and was determined statistically significant if P \u3c 0.05. All analyses were performed using IBM SPSS Statistics (Version 29; Armonk, NY). Results: After implementation, the interprofessional team identified alternative sources of bloodstream infection in 37 patients (17 in 2021 and 20 in 2022) with qualifying central access and positive blood culture. When comparing pre and post intervention periods, significant reductions were made (see Table 2). This included an 82$1.6 million difference in healthcare costs. Discussion: This project demonstrates that an interpersonal team reviewing potential CLABSIs and identifying alternative sources of BSI can decrease CLABSI rates, improve patient management and lead to better outcomes. In addition to being a safe and effective approach, this intervention had the additional benefit of cost savings for the health system. Healthcare institutions should consider implementing this intervention to reduce unnecessary CLABSI rates, as well as cost.https://scholarlycommons.henryford.com/nursresconf2023/1001/thumbnail.jp

Perceptions of Nurses Who Are Second Victims in a Hospital Setting

https://scholarlycommons.henryford.com/nursresconf2021/1004/thumbnail.jp

The Impact of an Oral Hygiene Bundle on Hospital Acquired Pneumonias

Background: Hospital acquired infections (HAIs) have a significant impact on patient outcomes with hospital acquired pneumonias (HAPs) accounting for a large part of the cost and care burden. At Henry Ford Hospital, the HAP rate over the last 3 years has increased from 1181 (June 2020) to 1869 (June 2021) to 1078 (June 2022), in large part due to the COVID 19 pandemic. Review of the literature shows that implementation of a nursing protocol with clearly defined steps helped to increase the number of patients receiving oral care and reduced the incidence of hospital acquired pneumonias (Warren, 2019). In addition, oral care as part of the VAP bundle significantly reduced the incidence of pneumonia when compared to oral care alone. Study Purpose: The primary purpose of this evidence based practice project is to evaluate the effectiveness of a standardized oral care regimen on HAPs for all patients in the hospital over a 6 month period following focused education for the nursing staff. Methodology: A site specific oral hygiene protocol was developed and replicated the protocol used by Warren (2019). Nursing staff were educated on the protocol via cornerstone module. Units were encouraged to have unit champions identified to support the implementation of the bundle. HAP rates, LOS and mortality rates were compared 3 months prior to bundle implementation to 3 months post-implementation. Data was abstracted from the EMR and included frequency and type of oral care performed. Data analysis: Data was extracted from the EMR collected in a 3-month period prior to bundle implementation and in a 3-month period post implementation. In each period HAP rates, LOS and mortality rates were computed. The two rates, HAP and mortality were compared using a Chi-squared test. and LOS using a Student’s t-test. Discussion: At Henry Ford Hospital, the HAP rate over the last 3 years has increased significantly, in large part to the COVID 19 pandemic. Research shows that implementation of a nursing oral care protocol with clearly defined steps helps to increase the number of patients receiving oral care and reduces the incidence of hospital acquired pneumonias Data from this project shows that as the number of oral care interventions increased there was a concomitant decrease in VAP. The education intervention resulted in increased adherence to the protocol as well as increase in documentation of care provided. In addition, length of stay decreased while discharge to home remain unchanged. Mortality rate and discharge to SAR both decreased slightly. Clinical Implications: The project is low risk with high benefit, and is a standard of care that all patients receive. This may influence how patients manage their own oral care after discharge. Study Limitations: The impact from Covid-19 is still present in the hospital, and may impact outcomes as related to available resources and manpower. Data retrieval was from the EMR and will only be as good as the data entered. Conclusion: Providing oral care is a simple and minimal cost intervention that can have significant impact on patient outcomes related to HAP. Educating staff on the value of oral care can help improve adherence to oral care protocols.https://scholarlycommons.henryford.com/nursresconf2023/1005/thumbnail.jp

Suicide rates amongst individuals from ethnic minority backgrounds: A systematic review and meta-analysis.

From Europe PMC via Jisc Publications RouterHistory: epub 2022-04-28, ppub 2022-05-01Publication status: PublishedBackgroundExisting evidence suggests that some individuals from ethnic minority backgrounds are at increased risk of suicide compared to their majority ethnic counterparts, whereas others are at decreased risk. We aimed to estimate the absolute and relative risk of suicide in individuals from ethnic minority backgrounds globally.MethodsDatabases (Medline, Embase, and PsycInfo) were searched for epidemiological studies between 01/01/2000 and 3/07/2020, which provided data on absolute and relative rates of suicide amongst ethnic minority groups. Studies reporting on clinical or specific populations were excluded. Pairs of reviewers independently screened titles, abstracts, and full texts. We used random effects meta-analysis to estimate overall, sex, location, migrant status, and ancestral origin, stratified pooled estimates for absolute and rate ratios. PROSPERO registration: CRD42020197940.FindingsA total of 128 studies were included with 6,026,103 suicide deaths in individuals from an ethnic minority background across 31 countries. Using data from 42 moderate-high quality studies, we estimated a pooled suicide rate of 12·1 per 100,000 (95% CIs 8·4-17·6) in people from ethnic minority backgrounds with a broad range of estimates (1·2-139·7 per 100,000). There was weak statistical evidence from 51 moderate-high quality studies that individuals from ethnic minority groups were more likely to die by suicide (RR 1·3 95% CIs 0·9-1·7) with again a broad range amongst studies (RR 0·2-18·5). In our sub-group analysis we only found evidence of elevated risk for indigenous populations (RR: 2·8 95% CIs 1·9-4·0; pooled rate: 23·2 per 100,000 95% CIs 14·7-36·6). There was very substantial heterogeneity (I2  > 98%) between studies for all pooled estimates.InterpretationThe homogeneous grouping of individuals from ethnic minority backgrounds is inappropriate. To support suicide prevention in marginalised groups, further exploration of important contextual differences in risk is required. It is possible that some ethnic minority groups (for example those from indigenous backgrounds) have higher rates of suicide than majority populations.FundingNo specific funding was provided to conduct this research. DK is funded by Wellcome Trust and Elizabeth Blackwell Institute Bristol. Matthew Spittal is a recipient of an Australian Research Council Future Fellowship (project number FT180100075) funded by the Australian Government. Rebecca Musgrove is funded by the NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC-2016-003)

Perceptions of Nurses Who Are Second Victims in a Hospital Setting

BACKGROUND: Second victims (SVs) are health care workers traumatized by unanticipated, adverse patient events. These experiences can have personal and professional effects on SVs. Research indicates that SVs experience inadequate support following adverse events. PURPOSE: To determine the prevalence of nurses who identified as SVs and their awareness and use of supportive resources. METHODS: A convenience sample of nurses was surveyed, and SV responses were compared with those who did not identify as a SV. Responses were analyzed using nonparametric methods. RESULTS: One hundred fifty-nine (44.3%) of 359 participants identified as SVs. There was a significant relationship between work tenure and SVs (P = .009). A relationship was found between SVs and awareness and use of support resources, with debriefing being the preferred method after an event. CONCLUSIONS: Adverse events trigger emotional trauma in SVs who require administrative awareness, support, and follow-up to minimize psychological trauma in the clinical nurse

Suicide rates amongst individuals from ethnic minority backgrounds: A systematic review and meta-analysis

Background Existing evidence suggests that some individuals from ethnic minority backgrounds are at increased risk of suicide compared to their majority ethnic counterparts, whereas others are at decreased risk. We aimed to estimate the absolute and relative risk of suicide in individuals from ethnic minority backgrounds globally. Methods Databases (Medline, Embase, and PsycInfo) were searched for epidemiological studies between 01/01/2000 and 3/07/2020, which provided data on absolute and relative rates of suicide amongst ethnic minority groups. Studies reporting on clinical or specific populations were excluded. Pairs of reviewers independently screened titles, abstracts, and full texts. We used random effects meta-analysis to estimate overall, sex, location, migrant status, and ancestral origin, stratified pooled estimates for absolute and rate ratios. PROSPERO registration: CRD42020197940. Findings A total of 128 studies were included with 6,026,103 suicide deaths in individuals from an ethnic minority background across 31 countries. Using data from 42 moderate-high quality studies, we estimated a pooled suicide rate of 12·1 per 100,000 (95% CIs 8·4–17·6) in people from ethnic minority backgrounds with a broad range of estimates (1·2–139·7 per 100,000). There was weak statistical evidence from 51 moderate-high quality studies that individuals from ethnic minority groups were more likely to die by suicide (RR 1·3 95% CIs 0·9–1·7) with again a broad range amongst studies (RR 0·2–18·5). In our sub-group analysis we only found evidence of elevated risk for indigenous populations (RR: 2·8 95% CIs 1·9–4·0; pooled rate: 23·2 per 100,000 95% CIs 14·7–36·6). There was very substantial heterogeneity (I2 > 98%) between studies for all pooled estimates. Interpretation The homogeneous grouping of individuals from ethnic minority backgrounds is inappropriate. To support suicide prevention in marginalised groups, further exploration of important contextual differences in risk is required. It is possible that some ethnic minority groups (for example those from indigenous backgrounds) have higher rates of suicide than majority populations